Radio-imagistica in ti Med.chir.
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Transcript of Radio-imagistica in ti Med.chir.
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RADIO-IMAGISTICA RADIO-IMAGISTICA IN SPECIALITATILE IN SPECIALITATILE
MEDICO-CHIRURGICALEMEDICO-CHIRURGICALE
•NEURO-RADIOLOGIENEURO-RADIOLOGIE
•OTO-RINO-LARINGOLOGIEOTO-RINO-LARINGOLOGIE
•OFTALMOLOGIEOFTALMOLOGIE
•ENDOCRINOLOGIEENDOCRINOLOGIE
•OBSTETRICA-GINECOLOGIEOBSTETRICA-GINECOLOGIE
© Rad/imag.IASI-1999-2003
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NEURO-RADIOLOGIENEURO-RADIOLOGIEMETODE DE RADIO-IMAGISTICA :
-RADIOGRAFIA STANDARD:schelet cranian,col.vertebrala
-CT;ANGIO-CT (CT spiral,multidetector);
-ANGIOGRAFIA Rx (DSA): -arc aortic,carotida,verteb rala;
-IRM +ANGIO-RM=> metoda de electie:cea mai fidela metoda de vizualizare a structurilor cerebrale si canalului/ maduvei spinale;
-ECOGRAFIA DOPPLER:carotidiana;
-transcraniana;transfontanelara
-SCINTIGRAFIA:SPECT;PET=aplicatii limitate
METODE DE RADIO-IMAGISTICA :
-RADIOGRAFIA STANDARD:schelet cranian,col.vertebrala
-CT;ANGIO-CT (CT spiral,multidetector);
-ANGIOGRAFIA Rx (DSA): -arc aortic,carotida,verteb rala;
-IRM +ANGIO-RM=> metoda de electie:cea mai fidela metoda de vizualizare a structurilor cerebrale si canalului/ maduvei spinale;
-ECOGRAFIA DOPPLER:carotidiana;
-transcraniana;transfontanelara
-SCINTIGRAFIA:SPECT;PET=aplicatii limitate
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RADIOGRAFIE
CRANIU PROFIL
Examenul Rx al scheletuli-primul practicat in traumatologia craniana
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RADIOGRAFIE
A BAZEI DE
CRANIU:
INCIDENTA
HIRTZ
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RADIOGRAFIE BAZA CRANIU:detaliu (Zoom digital)
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CT:CRANIU
AXIAL
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IRM CRANIO-CEREBRALA
PRIMA APLICATIE CLINICA IN URMA CU 23ANI;
-APLICATII ACTUALE= toata patologiatoata patologia cerebrala: cerebrala:
-Scleroza multipla (metoda unica,superioara CT);
-patologie vasculara :AVC,tromboze,infarcte,anevrisme;
-Malformatii A-V;anomalii de dezvoltare cerebrale;
-inventarul tumorilor –hipofiza, de fosa posterioara,nervi cr.;
-controlul rezultatelor dupa interventii terapeutice.
PRIMA APLICATIE CLINICA IN URMA CU 23ANI;
-APLICATII ACTUALE= toata patologiatoata patologia cerebrala: cerebrala:
-Scleroza multipla (metoda unica,superioara CT);
-patologie vasculara :AVC,tromboze,infarcte,anevrisme;
-Malformatii A-V;anomalii de dezvoltare cerebrale;
-inventarul tumorilor –hipofiza, de fosa posterioara,nervi cr.;
-controlul rezultatelor dupa interventii terapeutice.
© Rad/Imag.2002
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IRM:STRUCTURILE CEREBRALE;PLAN AXIAL
T-1 T-2
ventriculi
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IRM:STRUCTURI
CEREBRALE,
ORBITARE,
OCULAREn.optic
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IRM:STRUCTURILE CEREBRALE;PLAN SAGITAL
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APLICATII ALE APLICATII ALE RADIO- IMAGISTICIIRADIO- IMAGISTICII
DIAGNOSTICDIAGNOSTIC
•MALFORMATII CONGENITALE (chiar fetale,in utero);
•TRAUMATISME CRANIO-VERTEBRALE:fracturi,hematom;
•PATOLOGIE VASCULARA:-MAV,angioame, -ateromatoza: stenoze,ischemie,infarcte,ramolismente,anevrisme.
•INFECTII:-meningo-encefalite;abcese cerebrale;scleroza in placi;
•TUMORI:-PRIMITIVE:astrocitom,meningiom,meduloblastom
. -METASTATICE:de la cancer sin,pulmon,renal
etc.
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IRM FETALA,in utero: MALFORMATIE CEREBRALA :holoprosencefalieholoprosencefalie
IRM FETALA,in utero: MALFORMATIE CEREBRALA :holoprosencefalieholoprosencefalie
© Rad/Imag.2002
-S.cerebrala absenta temporo-occiptal,inlocuita cu lichid (hipersemnal omogen T2)
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CT:
CHIST
ARAHNOIDIAN TEMPORAL STG.
-formatiune expansiva cu continut lichidian pur si capsula periferica fina
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CT;
HIDROCEFALIE
SIST.VENTRICULAR DILATAT
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CT nativ:HEMATOAME POST-TRAUMATICE:
A)EPIDURAL;B).INTRACEREBRAL
A BHiperdensitate spontana (singe),cu halou limitant(edem,meninge)
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CT:
HEMATOM EPIDURAL
POST-TRAUMATIC
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CT:INFARCT CEREBRAL
Zona hipodensa neomogena cu stergerea structurilor cerebrale si partiala lichefiere
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CT:
INFARCT
CEREBRAL
INTINS
Clinic:Fibrilatie atriala;hemiplegie
-zona hipodensa,lichefiata partial cu disparitia structurii cerebrale occipital post.drept; -moderat halou periferic-edem; -zona nu capteaza contrastul iodat,care este vizibil in vase
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© Rad/Imag.2002
IRM-AX & SAG:SCLEROZA MULTIPLAIRM-AX & SAG:SCLEROZA MULTIPLA
IRM =singura
metoda ce reveleaza leziunile demielinizante
din SM
Placi de scleroza in s.alba dominant periventricular : benzi de hipersemnal T2
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IRM :Tumora cerebrala parietala dr.:invazie sist.ventricular,edem,hemoragii intratumorale
© Rad/Imag.2002
axial
coronal
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IRM ,T-2 AX& SAGITAL
TUMORA FRONTALA STGA (astrocitom)
edem
T
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© Rad/Imag.2002
IRM CEREBRALA:
TUM. UNGHI PONTO-CEREBELOS NERV ACUSTICO-VESTIBULAR(SCHWANOM)
-masa expansiva incapsulata cu hipersemnal T2,compresiva pe s.cerebrala hemi-cerebel dr.; -captare contrast in T1; -dilatare ventriculara secundara.
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IRM:TUMORA HIPOFIZARA:EXTENZIE SUPRASELARA
AXIAL
SAGITAL CORONAL © Rad/Imag.2002
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CT:TUMORA CEREBRALA DE UNGHI PONTO-CEREBELOS
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CT:
TUMORA
CEREBRALA;
SD.EXPANSIV,EDEM,
COMPRESIA
VENTRICULULUI LAT.
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CT:EXAMEN
POST
CRANIOTOMIE
TUMORA
CHISTICA
IN EVOLUTIE
-volet operator tensionat,cu protruzia de l.c.r si masa tumorala la exterior;edem masiv si disparitia structurilor cerebrale
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ECOGRAFIE cerebrala prin volet operator: TUMORA RESTANTA
Ventricul lateral
Tedem
Formatiune expansiva solida,hiperecogena,cu edem peritumoral (halou hipoecogen)
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CT:
METASTAZE CEREBRALE
(cancer mamar)
CT:
METASTAZE CEREBRALE
(cancer mamar)
-noduli multipli in substanta cerebrala,cu densitate diferita dupa contrastare:cerc opac periferic si zona centrala mai hipodensa
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IRM - T2:metastaze cerebeloase
(cancer mamar operat de 2 ani)© Rad/Imag.2002
-zone multiple nodulare,rotund-ovalare, in hipersemnal T2 cu halou periferic
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IRM :MAV CEREBELOASA hemoragica
nidus
© Rad/Imag.2002
-formatiune expansiva cerebeloasa dr. cu structura mixta,imagini serpiginoase lichidiene aspect vermicular (vase angiomatoase); -halou in hipersemnal (hemoragie)
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ANGIO-IRM CEREBRALA :RAPOARTE VASCULARE CU TUMORA-incidente variate 3D
T
© Rad/Imag.2002
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Angio-RM cu contrast Angio-RM cu contrast •Foloseste contrast paramagnetic tip Gadolinium( ex.: Magnevist-Schering AG);
•Injectarea iv.a contrastului manuala sau cu injectoare automate ;
•Cantitatea de s.c.-01-02 mmol/Kg corp;
•Viteza de injectare fctie de vasele vizate=0,5-1,5 ml/sec
•Momentul inceperii achizitiei datelor este selectat fctie de viteza /timpul de circulatie;soft-urile moderne de angio-RM permit detectare automata a fluxului de contrast in zona cercetata-reducind neconcordantele intre peak-ul maximal al concentratiei s.c. si achizitie.
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ANGIO-RM:CAROTIDE & VERTEBRALE
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VASELE CEREBRALE:ANGIO-IRM SI PREP. ANATOMIC
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ANGIO-RM:VENELE CEREBRALE
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ARTERIO-IRM 3D- AXIAL: art.cerebrale normale
© Rad/Imag.2002
a.cerebr.ant
r.temporale
r.parietale
r.occipitale
a.cerebr.mijlocie
a.cerebr.posterioara
a.comunicanta anterioara
a.Comunicanta posterioara
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a.cerebr.mijlocie
a.cerebr.anterioara
a.tr.bazilarcarotida
MIP coronal-aspect normal
© Rad/Imag.2002
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MIP sagital/oblic:aspect normal
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Angio-IRM,CORONAL:
TROMBOZA CAROTIDA DR.
MIP/SEGMENTARE
Carotida stga
© Rad/Imag.2002
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Angio-IRM/CONTRAST 3D - CORONAL:
STENOZA/TROMBOZA CAROTIDA STGA © Rad/Imag.2002
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Post-procesare:
Subtractie & segmentare
Angio-IRM /CONTRAST:stenoze carot.interna -bilateral
© Rad/Imag.2002
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Angio-IRM /CONTRAST:stenoze carot.interna -bilateral
Post-procesare:
Subtractie & segmentare
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AORTOGRAFIE-IRM,cu contrast:stenoza a.vertebrale
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AORTOGRAFIE Rx-DSA:arc aortic=>carotide/vertebrale normale
Carotida stga
Vertebrala stga
Carotida dr.
Vertebrala dr.
cateter
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AORTOGRAFIE Rx DSA TORACICA: stenoza carotida dr.;tromboza carotida com stga.
AORTOGRAFIE Rx DSA TORACICA: stenoza carotida dr.;tromboza carotida com stga.
stenoza
tromboza
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ANEV. A.CERBRALA MIJLOCIE:AIRM-CORONAL,MIP/SEGMENTARE
© Rad/Imag.2002
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MOVIE/AUTOPLAY
ANEV. A.CERBRALA MIJLOCIE:
AIRM-CORONAL,MPR,SEMENTARE/SURFACE RECONSTR./SPIN
spaiuc
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AngioIRM AngioIRM cerebralacerebrala
FUZIUNE CU FUZIUNE CU
CT -3DCT -3D
STUDIU EXPERIMENTAL
1995/ECR,VIENA/
INSTIT.MATEM.MED/
BIOLOGIE
HAMBURG,Germania
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ARTERIOGRAFIE Rx VERTEBRALA:anevrism bazilar
A.Vertebrala
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Angio-IRM:MAV (Malformatie Arterio-Venoasa)
Parietala stanga-in teritoriul Art.Cerebrale Mijlocii(ACM)
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ARTERIOGRAFIE Rx CAROTIDIANA:MALFORMATIE A-V
Vase aberante si lacuri vasculare in aria art.cerebrale mijlocii-temporo-occipital
PA LAT
DSA
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ARTERIOGRAFIE Rx
CAROTIDIANA DSA; faza venoasa
MALFORMATIE
ARTERIO-VENOASA: lacuri opace venoase abundente,conglomerate
PA
LAT
© Rad/Imag.2002
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IRM:coloana vertebrala lombo-sacrata: discartroza
IRM:coloana vertebrala lombo-sacrata: discartroza
T1-Post-contrast i.v.(Gadolinium )
© Rad/Imag.2002
-hipersemnal subchondral platouri vertebrale L5-S1;-scaderea grosimii discului intervertebral;captare contrast tip inflamator
T2 -nativ
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Post-contrast:captare
sagital
IRM CERVICALAIRM CERVICALA:Meningiom,C3-4
coronal
-Masa solida de parti moi,ovoida,incapsulata;capteaza intens contrast paramagnetic-deci = hipervascularizata; -compresie /ingustare a cordonului medular
C2
C4
Tcordon medularcompresat
nativ
nativ
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IRM:MALFORMATIE A-V (arterio-venoasa) VERTEBRO-MEDULARA
CORONAL
SAGITALAXIAL
© Rad/Imag.2002
Structuri vasculare anormale,serpiginoase vermiforme,in hipersemnal T2 ce ocupa canalul spinal si se extind lateral ; structuri medulare disparute
Clinic:paraplegie m inferioare.
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© Rad/Imag.2002
MIELOGRAFIE-IRMMIELOGRAFIE-IRM CERVICALA:
Canal spinal ingustat prin osteofitoza proeminata;compresiune a structurilor medulare
sagital
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Clinic:traumatism forte cervical;tetraplegie de 1 luna. IRM:DISCARTROZA PREEXISTENTA;
MODIFICARI MEDULARE SECUNDARE: -stenoze canal spinal etajate;ingustare cordon medular si
cavitate siringomielica mica ,structura cordonala disparuta.
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MODIFICARI VERTEBRALE POST-TRAUMATICE;
ingustare canal;cordon medular compresat secundar
Rx=NORMAL
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Clinic:”Discopatie”;IRM=Metastaze vertebro-medulare
mielo-IRM
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METASTAZE VERTEBRO-MEDULAREMETASTAZE VERTEBRO-MEDULARE
(Clinic:Rezectie Transuretrala:-cancer prostata).
© Rad/Imag.2002-distructii/tasari vertebrale multiple;-masa tumorala invadanta in canalul spinal
sagital
axial
T
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NEURORADIOLOGIE INTERVENTIONALA
•ANGIOPLASTIEANGIOPLASTIE PERCUTANA TRANSLUMINALA: PERCUTANA TRANSLUMINALA: in stenozele arteriale ateromatoase carotidiene,vertebralein stenozele arteriale ateromatoase carotidiene,vertebrale
•EMBOLIZAREEMBOLIZARE TERAPEUTICA: TERAPEUTICA:FAV,anevrisme;FAV,anevrisme;
•CHEMOTERAPIECHEMOTERAPIE INTRAARTERIALA selectiva: - INTRAARTERIALA selectiva: -tromboze vasculare,tumori maligne;tromboze vasculare,tumori maligne;
•IRADIEREIRADIERE INTERSTITIALA transcutana; INTERSTITIALA transcutana;
•““GAMMA KNIFE”:iradiere externa stereotactica, GAMMA KNIFE”:iradiere externa stereotactica, ghidata CT-in tumori maligne.ghidata CT-in tumori maligne.
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ANGIOPLASTIA CAROTIDEI
• INDICATII:-stenoze strinse -60-70% -ce nu beneficiaza de
endartrectomie chirurgicala (datorita unor contraindicatii)
-accidente vasculare tranzitorii repetate;-re-stenozarea dupa endarterectomie;-leziuni inaccesibile chirurgical (la ostium sau
inalte,retromandibular)• CONTRAINDICATII:-tromboza completa;-
hemoragie cerebrala;-atac ischemic major,cu paralizii definitive;-tumori cerebrale.
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TEHNICA APT CAROTIDA COMUNA STANGA
Abord transfemural
-cateter-balon pozitionat intra-stenotic; balonul degonflat; -balon protectie cerebrala gonflat supra stenotic
axial
Balon protectie cerebrala
Balon terapeutic degonflat
Procedura se executa sub control fluoroscopic,cu contrast iodat
Carotida dreapta
Tr.brahiocefalicTr.brahio
cefalic
a.vertebrala
a.subclaviculara
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
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TEHNICA APT CAROTIDA COMUNA STANGA
Abord transfemural
-cateter-balon pozitionat intra-stenotic; balonul gonflat maximal; -balon protectie cerebrala gonflat
axial
Balon protectie cerebrala
Balon terapeutic
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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ENDOPROTEZARE PERCUTANA:introducerea protezei montate pe cateter-balon prin teaca arteriala femurala
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ENDOPROTEZARE CAROTIDA COMUNA STANGA
Abord transfemural
-Cateter-balon cu proteza pozitionata intra-stenotic,dupa pre-dilatatie; -balonul degonflat,proteza colabata pe balon; -balon protectie cerebrala gonflat suprastenotic
axial
Proteza colabata
Balon protectie cerebrala
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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ENDOPROTEZARE CAROTIDA COMUNA STANGA
Abord transfemural
-cateter cu balonul gonflat maximal; proteza expandata ; -balon protectie cerebrala gonflat
axial
proteza
Balon protectie cerebrala
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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ENDOPROTEZARE CAROTIDA COMUNA STANGA
Abord transfemural
CONTROL AORTOGRAFICaxial
proteza
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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ENDOPROTEZARE CAROTIDA STANGA INTERNA-BIFURCATIE
Abord transfemural
-proteza colabata pe balonul degonflat,pozitionata intrastenotic,
dupa pre-dilatatie; -balon protectie cerebrala gonflat
Balon protectie cerebrala
proteza
axial
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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Balon protectie cerebrala
proteza
ENDOPROTEZARE CAROTIDA STANGA INTERNA-BIFURCATIE
Abord transfemural
- balonul terapeutic gonflat maximal si proteza expandata; -balon protectie cerebrala gonflat
axial
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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Balon protectie cerebrala
proteza
ENDOPROTEZARE CAROTIDA STANGA INTERNA-BIFURCATIE
Abord transfemural
-aspirare fragmente aterom prin cateterul-tutore,dupa extragerea cateterului cu balon;
-balonul de protectie cerebrala gonflat.
Cateter tutore 8Fr
aspira
Cateter-tutore
axial
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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proteza
ENDOPROTEZARE CAROTIDA STANGA INTERNA-BIFURCATIE
Abord transfemural
ARTERIOGRAFIE de CONTROLaxial
Jet contrast iodat
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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Balon protectie cerebrala
Proteza expandata
ENDOPROTEZARE CAROTIDA DREAPTA INTERNA-BIFURCATIE
Abord transfemural
- balonul gonflat maximal si proteza expandata;
-balon protectie cerebrala gonflat
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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Proteza expandata
ENDOPROTEZARE CAROTIDA DREAPTA INTERNA-BIFURCATIE
Abord transfemural
ARTERIOGRAFIE CONTROL
contrast
© Rad/Imag.Iasi-2003© Rad/Imag.Iasi-2003
Procedura se executa sub control fluoroscopic,cu contrast iodat
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stenoza
ANGIOPLASTIA & ENDOPROTEZAREA CAROTIDEI COMUNE DREPTE
1 2 3
4 5 6
Arteriografie pre-APT
balon
Cateterism selectiv Pozitionare/gonflare
Gonflare/expandare proteza
proteza
Angiografie finala DSA
lumen recalibrat
Degonflare/retragere balon
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US –duplex (mod B& DOPPLER color)
STENOZA ATEROMATOASA A CAROTIDEI INTERNE: -placi proieminate in lumen,calcificate(vid sonic posterior); -flux turbionar (“mozaic”)intrastenotic
Cazul continua
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ANGIOPLASTIE CAROTIDIANA INTERNA:
A)arteriografie cu subtractie digitala pre-interventionala; -stenoza ateromatoasa peste 60% a carotidei interne;
B)cateter de angioplastie cu balonul gonflat intra-stenotic;
C)arteriografie de control:recalibrarea lumenului carotidian
A B C
POST-APT
(Studiul US Doppler-in pg.precedenta)
PRE-APT
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RADIO-IMAGISTICA O.R.L.O.R.L.
INDICATII;METODE:
OTO==>exam.urechii medii/interne:infectii,traumatisme,tumori
==>radiografii+tomo:incidente:Schűller,Stenvers,Hirtz;
==>CT;IRM;angioDSA (carotidiana).
RINO=>exam.sin.fetei,orif.nazale,rinofaringe:idem OTO;
==>rad+tomo:incidente:Blondeaux,Hirtz,cr.profil;
==>CT;IRM.
LARINGO-FARINGE:t.b.c.;tumori:c.vocale,vestibul,glota etc.
==>CT;IRM;fluorografie +bariu/Lipiodol(faringe)
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CT:EX.AXIAL PENTRU RINOFARINGE,
SFENOID,BAZA DE CRANIU,SINUSURI MAXILARE
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CT:STRUCTURA URECHII MEDII/INTERNE
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CT:
SECTIUNI
OBLICE
PRIN
URECHEA
MEDIE/
INTERNA, BILATERAL
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RADIOGRAFIE A
SINUSURILOR MAXILO-
FACIALE:
-tumora sinus maxilar dr.;
-ingrosare mucoasa sin max sting.
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IRM IN OTO-RINO-LARINGOLOGIE
APLICATII :Diagnostic de prezenta,etiologie si extenzie in urmatoarele afectiuni:
-CANCER HIPO/RINOFARINGE,LARINGE;
-TUMORI BENIGNE-NEURINOM,FIBROM;
-SUPURATII;
-CHISTURI ,SINUZITE,MUCOCEL;
-DECELAREA CANCERELOR OCULTE,CU METASTAZE GANGLIONARE CERVICALE PRECESIVE.
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SINUSITA CRONICA
& CHIST SIN.MAXILAR
© Rad/Imag.2002
AX
CORONAL
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IRMN:
BAZA CRANIULUI
INCIDENTA
AXIALA:
NEURINOM
DE
ACUSTIC miniatural
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IRM CERVICALA:CANCER LARINGIAN
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IRM CERVICALA:CANCER LARINGIAN
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Angio-DSA
CAROTIDA:
TUMORA
JUGALA
MALIGNA
Vase de neoformatie alimentate de ramuri carotida externa (maxilara)
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IMAGISTICA IMAGISTICA OFTALMOLOGICAOFTALMOLOGICA
OBIECTIV:OBIECTIV:Vizualizarea directa a globului ocular+anexeVizualizarea directa a globului ocular+anexe si a orbiteisi a orbitei
METODE:-METODE:-IRMIRM=>met.de electie pt.toate structurile;=>met.de electie pt.toate structurile;
--USUS==>==>corpi straini,dezlipire retina,tumori.corpi straini,dezlipire retina,tumori.
--CTCT=>=>tumori+invazie orbitara;tumori+invazie orbitara;
--Rad.clasicaRad.clasica:orbite,baza cr.,gauri optice;:orbite,baza cr.,gauri optice;
--Rad.cu grila de caroiajRad.cu grila de caroiaj==>corpi straini opaci Rx==>corpi straini opaci Rx
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ECOGRAFIE OCULARA:CORP STRAIN
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ECOGRAFIE OCULARA:MODIFICARI POST-TRAUMATICE
-dezlipire de retina;-sinechii in vitros;scaderea sfericitatii-ratatinare
decolare retiniana
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US OCULARA:
-sinechii in vitros;
-dezlipire retina
Clinic:traumatism ocular direct
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ECOGRAFIE OCULARA:DEZLIPIRE DE RETINA
Mod TM
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ECOGRAFIE OCULARA:TUMORA RETROOCULARA
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US:TUMORA RETRO-OCULARA
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IRM IN OFTALMOLOGIE
APLICATII :
-TUMORI ORBITARE,GLOB OCULAR;
-SUPURATII ORBITARE;
-NEVRITE,MIOZITE.
-DG.DIFERENTIAL AL EXOFTALMIEI.
© Rad/Imag.2002
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IRM:STRUCTURI
CEREBRALE,
ORBITARE/
OCULARE=normale
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IRM T2:MELANOAME OCULARE
--nodul ovoid in hipersemnal,acolat la structurile parietale ale globului ocular; -stergerea interfetei externe a tumorii sugereaza extenzia extraglobulara.
coronal
axial
cristalinul
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IRM,T2:
MUCOCEL SINUS FRONTAL
Exoftalmie compresiva secundara
Glob ocular
colectie
sagital
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RADIO-IMAGISTICA IN RADIO-IMAGISTICA IN ENDOCRINOLOGIEENDOCRINOLOGIE
APLICATII IN STUDIUL:-TIROIDEI/PARATIROIDELOR;
-OVARELOR -GL.MAMARE;
-TESTICULULUI;
-GL.SUPRARENALE; -HIPOFIZEIMETODE:-ULTRASONOGRAFIE- mod B & DOPPLER; -CT; -SCINTIGRAFIE; -IRM;
-ANGIOGRAFIE:rar indicata;
-flebografie spermatica-pt.localizarea unui testicul ectopic nedecelat prin alte metode;embolizare varicocel in infertilitatea masculina secundara.
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GLANDA TIROIDAMETODE:-SCINTIGRAMA I-131;US-7-10 Mhz+Doppler color&Angio Power;CT;IRMN,RAD.STANDARD (torax).
ASPECTE:-marime,structura (toate met.);
-functie(Scintigrafia-iodocaptare)
INDICATII: -TIROIDITE, -GUSA ENDEMICA
-TIROIDA PLONJANTA,-ABERANTA,
-CHISTURI,
-ADENOAME,
-CANCER.
RAD.INTERVENTIONALA:punctii ecoghidate,scleroterapia prin alcoolizare=>chisturi,adenoame.
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V jugulara
US mod B & Doppler:TIROIDA NORMALA
LARINGE
Lob dr.
istm
Lob stg
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US:GUSA NODULARA:hipertrofie bilobara;noduli hipoecogeni,mai evidenti si voluminosi in lobul drept
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US mod B & Doppler:lob dr.tiroidian hipertrofiat;nodul adenomatos cu halou vasculat periferic
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US TIROIDIANA:NODULI HIPOECOGENI,CALCIFICARI
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US DOPPLER POWER ANGIO COLOR:NODULI TIROIDIENI HIPERVASCULARIZATI
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US.DOPPLER ANGIO POWER COLOR-TIROIDA
NODUL ADENOMATOS-HIPERVASCULARIZAT
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GLANDE PARATIROIDEGLANDE PARATIROIDE
METODE:-SCINTIGRAFIE=>tehnica dublului trasor:I-131 +
+Tallium 201; -ULTRASONOGRAFIE mod B & Doppler
INDICATII:-ADENOM SECRETANT (parathormon=hiper- paratiroidie) –din boala RECKLINGHAUSEN (osteoza paratiroidiana);se examineaza Rx intregul schelet,care prezinta modificari caracteristice:osteoporoza,rezorbtii chistice etc.
LOCALIZAREA ADENOMULUI se poate face prin:
-US si IRM=tumori > de 8 mm; -SCINTIGRAFIE; -ARTERIOGRAFIE SELECTIVA (tr.tiro-scapulo-vertebral)
RAD.INTERVENTIONALA:punctie cu fin acecoghidata => si scleroterapie percutana prin alcoolizare
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OVARE
METODE:-ULTRASONOGRAFIA TRANSABDOMINALA;
-ENDOSONOGRAFIA TRANSVAGINALA
-IRM- pelvis/abdomen (sd.malformative complexe)
INDICATII: -OVARE POLICHISTICE;
-TUMORI OVARIENE SECRETANTE;
-SD.MALFORMATIVE:agenezii uter/ovar etc.
(Vezi si “ginecologie”)
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GLANDA MAMARAMETODE:-MAMOGRAFIA;
-ULTRASONOGRAFIA mod B,7-10Mhz,Doppler ;
-GALACTOGRAFIA;
-IRM
INDICATII:-MASTOZA FIBRO-CHISTICA;
-MAMELA SECRETANTA;
-FIBROADENOMUL;
-CANCERUL MAMAR-(ginecologie).
RAD.INTERVENTIONALA:PUNCTIA GHIDATA IMAGISTIC in scop diagnostic (cito-biopsie) si terapeutic (chisturi,abcese).
(vezi si “ginecologie”)
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TESTICUL
METODE:-ULTRASONOGRAFIA-mod B ,Doppler color;
-IRM;
-FLEBOGRAFIA SPERMATICA;
INDICATII:-CRIPTORHIDIA:detectia testicul necoborit-ectopic;
-TUMORI SECRETANTE(LEIDIG)(ginecomastie..);
-VARICOCEL=>INFERTILITATE MASCULINA;
RAD.INTERVENTIONALA:-EMBOLIZARE V.SPERMATICA
PENTRU VARICOCEL=>reduce infertilitatea sec.masculina 50%
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HIDROCEL
TUMORA TESTICULARA
LICHIDtesticul
-nodul hipoecogen,structura neomogena,contur capsulat , neregulat
-imagine transsonica omogena ce inconjura testiculul-(reflectogen)
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US TESTICUL:ORHITA SUPURATA;microabcese
-imagini ovoide hipoecogene cu contur neregulat si interfata mai reflectogena(membrana piogena)
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US DOPPLER COLOR TESTICULARA:ORHITA ACUTA
-edem si congestie abundenta ; -hipervascularizare cu distributie normala
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US mod B:TESTICUL ECTOPIC in canalul inghinal
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GLANDE SUPRARENALEMETODE:-ULTRASONOGRAFIA mod B & Doppler color; -CT+CONTRAST;
-IRM; -ARTERIOGRAFIA SELECTIVA(a.diafragmatica,ren.)
INDICATII:-B.ADISSON (insuficienta suprarenala);
-HIPERPLAZII GLANDULARE CORTICALE:
- b.Cushing,sd.adreno-genital; -TUMORI MEDULARE SECRETANTE:Clinic=HTA: -adenom CONN (hiperaldosteronism primar); -feocromocitom
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US:SD.ADRENO-GENITAL:hiperplazie suprarenaliana(virsta-6 luni)
SR
REN
FICAT
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US:TUMORA DE SUPRARENALA STG.
REN
© Rad/Imag.Iasi-2002
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US:TUMORA SUPRARENALA DREAPTA
© Rad/Imag.Iasi-2002
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US:TUMORA SUPRARENALA DR.:feocromocitom
VCI
ficat
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US: TUMORA SUPRARENALA DREAPTA.
renT
© Rad/Imag.Iasi-2002
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FICAT
REN
US: TUMORA SUPRARENALIANA DREAPTA
-formatiune expansiva reflectogena,cu impedanta de tip parenchimatos
© Rad/Imag.Iasi-2002
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© Rad/Imag.Iasi-2002© Rad/Imag.Iasi-2002
IRM & URO-IRM:
TUMORA SUPRARENALA DR.
(FEOCROMOCITOM)
coronal
axial
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IRM ,T1 CORONAL:TUMORA SUPRARENALA
(CORTICOSUPRARENALOM)
© Rad/Imag.Iasi-2002© Rad/Imag.Iasi-2002
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HIPOFIZA
METODE:-DIRECTE:IRM,CT;
-INDIRECTA=>Rad.standard +tomo plana- sellara
INDICATII:-ADENOMUL HIPOFIZAR CROMAFIL=>
exces de hormon somatotrop=>GIGANTISM(copil);
=>ACROMEGALIA(adult);
Ex.complementare:radiografierea pieselor scheletice afectate
-ADENOM HIPOFIZAR CROMOFOB=>
exces de LDH=>sd.clinic caracteristic (galactoree/amenoree)
(Vezi si “Neuroradiologie”)
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CT:ADENOM
HIPOFIZAR IN
ACROMEGALIE
T
-masa expansiva intraselara ce largeste spatiul interclinoidian;
-captare neomogena a contrastului,care creste opacitatea masei tumorale
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CT:ADENOM HIPOFIZAR:mica tumora incapsulata, intens opacefiata cu contrast iodat
Sectiuni axiale fine-2mm
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SELLA TURCICA GOALA (“SELLA TURCICA GOALA (“EMPTY SELLAEMPTY SELLA”): ”): -clinic,unii pacienti prezinta insuficienta hipofizara-clinic,unii pacienti prezinta insuficienta hipofizara
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IMAGISTICA IN OBSTETRICA/GINECOLOGIE
IMAGISTICA IN OBSTETRICA/GINECOLOGIE
METODE:-US: -pelvis,gl mamara;
-IRM:-pelvis ,gl.mamara;
-CT :pelvi-abdominala ,in tumori;
-HISTEROSALPINGOGRAFIA;
-MAMOGRAFIA;
-GALACTOGRAFIA.
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IMAGISTICA GINECOLOGICA:indicatii
I.PELVIS:-METRITE,ANEXITE;PELVIPERITONITE; -TUMORI BENIGNE:-fibrom uterin;chisturi ovar; -TUMORI MALIGNE:-cancer col/corp uterin; -cancer ovarian; Se apreciaza :-prezenta,natura, -extenzia loco-regionala,metastazarea. -ENDOMETRIOZA;DG.INFERTILITATII.II.MAMARA:-DISPLAZII MAMARE:mastoza fibro-chistica; -TUMORI BENIGNE:-fibroadenom; -papilom intraductal; -TUMORI MALIGNE: 90%=carcinom ductalRAD.INTERVENTIONALA:-punctii eco-ghidate (cy,tumori);-embolizare hipogastrica in metroragii intratabile (tumori);-recoltare de ovul cu ghidaj US=>pt.fertilizare in vitro
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US-3D:UTER NORMAL:endometru
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US US 3D:UTER SEPTAT,BIFID
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INSTRUMENT INTRAUTERIN ANTICONCEPTIE (sterilet)
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US PELVIS:FIBROAME UTERINE
Noduli hipoecogeni incapsulati,cu calcificari, in grosimea interstitiului miometrial
vezica
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US:FIBROM UTERIN
-nodul reflectogen incapsulat in grosimea peretelui uterin
© Rad/Imag.2002
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US mod B & DOPPLER COLOR:
ADENOCARCINOM DE ENDOMETRU
Masa endocavitara cu numeroase vase neoformate periferice si centrale (Doppler)
vezica
© Rad/Imag.2002
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US:CANCER DE COL UTERIN
vezica
-nodul hipoecogen,contur neregulat ce mareste diametrul reg.cervix-ului
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US TRANSVAGINALA:OVAR POLICHISTIC
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US:CHIST OVARIAN VOLUMINOS
vezica
Formatiune expansiva transsonica incapsulata parauterina
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US-DOPPLER COLOR:TUMORA DE OVAR
vezica
uter
Formatiune expansiva hipoecogena cu vase neoformate periferice si centrale
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TUMORA MALIGNA DE
OVAR:
STUDIU US DOPPLER ANGIO POWER COLOR
vezica
uter
tum
Masa expansiva de tip solid,cu vase neoformate abundente central,in topografie parauterina dreapta
Mod B
© Rad/Imag.2002
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ASCITA
TUM
US:CANCER DE OVAR
-masa reflectogena cu contur anfractuos, aderenta la peretele pelvian si vezica; -ascita =zona transsonica in pelvis,conturind tumora
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TUM
ASCITA
US:CANCER OVARIAN
Masa expansiva solida,hipoecogena,cu zone centrale transsonice -lichefiere necrotica tumorala.
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IRM PELVIS FEMININ
APLICATII IN GINECOLOGIE:
-TUMORI UTER,ANEXE,COL UTERIN;
-STADIALIZARE TNM a cancerelor ;
APLICATII IN OBSTETRICA:
-malformatii fetale (in studiu…)
© Rad/Imag.2002
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IRM PELVINA:
Fibromatoza uterina;
anexita dreapta
© Rad/Imag.2002
SAGITAL
CORONAL
-masa multinodulara ocupanta,contur policiclic,ce mareste global uterul
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VU
CANCER COL UTERSt.IIbIRM -T2/SAGITAL
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CANCER COL UTER St.IIIbIRM -T2/SAGITAL
CANCER COL UTER St.IIIbIRM -T2/SAGITAL
Invazie vezicala
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URO-IRM+T2 pelvin:URO-IRM+T2 pelvin:CARCINOM COL UTERIN,st.III.
HIDRONEFROZA prin compresiune/invazie ureterala data de adenopatii retroperitoneale
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Cancer de col uterin st.IIIb
invazie vezicala
Ultrasonografie
IRM -AX
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IRM NATIV:Cancer ovar;ascita;mts hepatice
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HISTEROSALPINGOGRAFIE:HIDROSALPINX
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HISTEROSALPINGOGRAFIE: OBSTRUCTIE TUBARA
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PATOLOGIA GLANDEI MAMARE
PATOLOGIA GLANDEI MAMARE
• Radio-imagistica constituie o parte importanta din explorarile diagnostice pre-terapeutice in toata patologia mamara si indeosebi in:
- cancerul mamar - patologia mamara benigna: mastita,mastopatia
fibro-chistica, fibro-adenoame
- Metodele aplicate:mamografia Rx,US,IRM
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MAMOGRAFIAMAMOGRAFIA
INDICATIIINDICATII:1)-SCREENING=>populatia cu risc:40-70 ani:1)-SCREENING=>populatia cu risc:40-70 ani
- examinare anual/la 2 ani;risc carcinogen=0;- examinare anual/la 2 ani;risc carcinogen=0;
2)-Nodulul palpabil solitar;2)-Nodulul palpabil solitar;
3)-Mamela secretanta/singerinda=>completata cu3)-Mamela secretanta/singerinda=>completata cu
galactografiagalactografia(ductografia).(ductografia).
TEHNICA:TEHNICA:2 incidente obligatorii2 incidente obligatorii:Cranio-Caudal (CC);:Cranio-Caudal (CC);
Medio-Lateral-Oblic(MLO) Medio-Lateral-Oblic(MLO)
- - compresiunea sinuluicompresiunea sinului;;
- - tehnici complementaretehnici complementare:incid laterala,marire(zoom):incid laterala,marire(zoom)
marcare cutanata opaca a nodulului etc.marcare cutanata opaca a nodulului etc.
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TEHNICA EXECUTARIITEHNICA EXECUTARII
MAMOGRAFIILOR:MAMOGRAFIILOR:
POZITIA PACIENTEI SIPOZITIA PACIENTEI SI
COMPRESIUNEA COMPRESIUNEA SINULUI
A)-INCIDENTA CranioCaudalaA)-INCIDENTA CranioCaudala
B)-INCIDENTA MedioLaterala/OblicaB)-INCIDENTA MedioLaterala/Oblica
AA
BB
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INTERPRETAREA MAMOGRAFIEI
RADIOLOGUL SPECIALIZAT,CERCETEAZA:
-CALCIFICARI IN TES.GLANDULAR;CALCIFICARI IN TES.GLANDULAR;
-MASE OPACE NODULARE;-MASE OPACE NODULARE;
-MODIFICARILE ARHITECTONICEI GLANDEI;-MODIFICARILE ARHITECTONICEI GLANDEI;
-MODIFICARI VOLUMETRICE;-MODIFICARI VOLUMETRICE;
-MODIFICARI CUTANATE (ingrosare,retractie);-MODIFICARI CUTANATE (ingrosare,retractie);
-ADENOPATII AXILARE;-ADENOPATII AXILARE;
--Examenul clinic al sinului,bilateral=OBLIGATORIUExamenul clinic al sinului,bilateral=OBLIGATORIU
© Rad/Imag.Iasi-2002
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MAMOGRAFIE INCIDENTA CRANIO-CAUDALA: ADENOAME MAMARE MULTIPLE
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CANCER DUCTAL INVAZIV:NODULI< DE 1 CM(screening)CANCER DUCTAL INVAZIV:NODULI< DE 1 CM(screening)
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MAMOGRAFIE MARITA :MAMOGRAFIE MARITA :cancer ductal =>microcalcificaricancer ductal =>microcalcificari
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GALACTOGRAFIEGALACTOGRAFIE:PAPILOAME DUCTALE :PAPILOAME DUCTALE
© Rad/Imag.2002-Iasi
-injectia de contrast iodat cu ac fin, prin mamelon ,direct intraductal,
-lacune in opacitatea contrastului din canalul galactofor afectat.
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ULTRASONOGRAFIAULTRASONOGRAFIA
INDICATIIINDICATII
1)Metoda primara la femei sub 30 ani,simptomatice;1)Metoda primara la femei sub 30 ani,simptomatice;
2)Caracterizarea oricarui nodul solitar descoperit clinic±2)Caracterizarea oricarui nodul solitar descoperit clinic±
mamografie incerta;mamografie incerta;
3)Examenul sinului hiperdens, la gravide,lactatie;3)Examenul sinului hiperdens, la gravide,lactatie;
4)In tandem cu mamografia la sinul foarte dens;4)In tandem cu mamografia la sinul foarte dens;
5)Sinul operat;sinul iradiat;5)Sinul operat;sinul iradiat;
6)Sinul cu proteza (implant6)Sinul cu proteza (implant))
© Rad/Imag.Iasi-2002
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TEHNICA TEHNICA ULTRASONOGRAFIEIULTRASONOGRAFIEI
-punct reper=mamelon;-punct reper=mamelon;
-scanare sectoriala,-scanare sectoriala,
-metodica,contigua,-metodica,contigua,
-uniforma;-uniforma;
-incidente variate;-incidente variate;
-decubit+decubit lateral,-decubit+decubit lateral,
ortostatism;ortostatism;
-scanarea axilei si a reg.-scanarea axilei si a reg.
Supraclaviculare.Supraclaviculare.
EX.BILATERAL !!EX.BILATERAL !!
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ULTRASONOGRAFIA
CRITERII GENERALE DECRITERII GENERALE DE
BENIGNITATEBENIGNITATE
CRITERII GENERALE DECRITERII GENERALE DE
BENIGNITATEBENIGNITATE1)ORIENTAREA=>1)ORIENTAREA=>orizontala:”mai lat decit inalt”;orizontala:”mai lat decit inalt”;
2)CONTURUL=>2)CONTURUL=>regulat,capsular,interfata pastrata tes.vecine;regulat,capsular,interfata pastrata tes.vecine;
3)STRUCTURA=>3)STRUCTURA=>uniforma,omogena;uniforma,omogena;
4)CALCIFICARI=>4)CALCIFICARI=>grosiere,circulare,rotunde;grosiere,circulare,rotunde;
5)VID SONIC POSTERIOR=>5)VID SONIC POSTERIOR=>tangent,marginal,liniar(interfata)tangent,marginal,liniar(interfata)
6)INTARIRE ECOU POST.=>6)INTARIRE ECOU POST.=>mare(chist),medie/mica(adenom);mare(chist),medie/mica(adenom);
7)COMPRESIBILITATE=>7)COMPRESIBILITATE=>evidenta.evidenta.
Rad/imag.Iasi-2002
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ULTRASONOGRAFIA
NODUL MAMAR BENIGNNODUL MAMAR BENIGN::CARACTERE SONOGRAFICE PARTICULARECARACTERE SONOGRAFICE PARTICULARE
1)FIBROADENOM=>1)FIBROADENOM=>ovoid,capsulat,intarire de ecou post.;ovoid,capsulat,intarire de ecou post.;
2)CHIST=>2)CHIST=>anecoic(“transsonic),capsula/septuri subtiri,conturanecoic(“transsonic),capsula/septuri subtiri,contur
int/ext.neted;intarire ecou post=maximala;int/ext.neted;intarire ecou post=maximala;
3)LIPOM=>3)LIPOM=>hiperreflectogen,oval,incapsulat,multiplu;hiperreflectogen,oval,incapsulat,multiplu;
4)ABCES=>4)ABCES=>continut neomogen,contur sters/capsular(cr),continut neomogen,contur sters/capsular(cr),
canale dilatate;edem.canale dilatate;edem.
5)HEMATOM=>5)HEMATOM=>partial lichidian,apoi neomogen/=>lichidianpartial lichidian,apoi neomogen/=>lichidian
N.B.:ORICE DUBIU SE REZOLVA PRIN PUNCTIE !N.B.:ORICE DUBIU SE REZOLVA PRIN PUNCTIE !
NB.2:NB.2:IRM MAMARA,INAINTE DE PUNCTIE !IRM MAMARA,INAINTE DE PUNCTIE !
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SEMEIOLOGIE ULTRASONOGRAFICA:SEMEIOLOGIE ULTRASONOGRAFICA:nodul mamar benignnodul mamar benign
-contur-contur-structura-structura
-intarire ecou-intarire ecou-tes.vecine-tes.vecine
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US:US:mastopatie fibro-chisticamastopatie fibro-chistica
-chisturi-transsonice,intarire de ecou posterioara; -noduli hipoecogeni mici,ovali; -ccalcificari grosiere,de tip benign
cy n
calcificari
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ULTRASONOGRAFIE: ULTRASONOGRAFIE: mastoza fibro-chisticamastoza fibro-chistica
-imagini transsonice multiple,ovoide,ax lung orizontal; -intarire posterioara de ecou
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US:US:mastopatie fibrochistica:chisturi mari,cu calcificari parietalemastopatie fibrochistica:chisturi mari,cu calcificari parietale
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US mod B& Doppler color:: FIBROADENOM MAMAR FIBROADENOM MAMAR
-nodul ovoid,solid, hipoecogen, cu contur net,capsulat; -axul lung este orientat orizontal;hipovascular.
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ULTRASONOGRAFIA
CRITERII GENERALE DE MALIGNITATECRITERII GENERALE DE MALIGNITATE
1)ORIENTAREA=>1)ORIENTAREA=>verticala:”mai inalt decit lat..”;verticala:”mai inalt decit lat..”;
2)CONTURUL =>2)CONTURUL =>neregulat,spiculat,lobulat;-anterior=hiper- neregulat,spiculat,lobulat;-anterior=hiper- reflectogen (“coroana”,”halou malign” reflectogen (“coroana”,”halou malign” (Takehara)(Takehara));-posterior= );-posterior= sters,umbrit=>vid sonic posterior; sters,umbrit=>vid sonic posterior;
3)STRUCTURA =>3)STRUCTURA =>neomogena,mixta;neomogena,mixta;
4)IMPEDANTA ACUSTICA:4)IMPEDANTA ACUSTICA:-hipoecogenicitate;-hipoecogenicitate;
5)CALCIFICARI=>5)CALCIFICARI=>micro;”in masa”;micro;”in masa”;
6)COMPRESIBILITATE=>6)COMPRESIBILITATE=>absenta,redusaabsenta,redusa
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ULTRASONOGRAFIACARACTERE SONOGRAFICE PARTICULARECARACTERE SONOGRAFICE PARTICULARE
1)1)Carcinom ductal invazivCarcinom ductal invaziv=>canale dilatate adiacent tumorii;=>canale dilatate adiacent tumorii;
2)2)Carcinom medularCarcinom medular=>contur lobulat,relativ net -adenomlike=>contur lobulat,relativ net -adenomlike
dar mai reflectogen;dar mai reflectogen;
3)3)Carcinom mucoidCarcinom mucoid=>aspect pseudochistic,dar contur mai =>aspect pseudochistic,dar contur mai neregulat intern…dg.dificil ;necesita punctie/cito/bio;neregulat intern…dg.dificil ;necesita punctie/cito/bio;
4)4)Chisto-sarcomul philodesChisto-sarcomul philodes=>structura mai neomogena decit =>structura mai neomogena decit
chisturile,septare groasa;contur intern anfractuos/edem ext.;chisturile,septare groasa;contur intern anfractuos/edem ext.;
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CRITERII Sensibilitate % Specificitate%
Orientare 68 95
Contur 42 81
Structura 32 39
Impedanta 44 55
Microcalcificari 68 89
Compresibilitate 67 87
CRITERII Sensibilitate % Specificitate%
Orientare 68 95
Contur 42 81
Structura 32 39
Impedanta 44 55
Microcalcificari 68 89
Compresibilitate 67 87
VALOAREA CRITERIILOR US
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SEMEIOLOGIE ULTRASONOGRAFICA: SEMEIOLOGIE ULTRASONOGRAFICA: CANCER DUCTALCANCER DUCTAL
calcificari
Vid sonicVid sonic
Coroana Takehara
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Vid Vid sonicsonic
US modUS mod B:B:CANCER MAMAR MICCANCER MAMAR MIC
Carcinom ductal St.T-1
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US:-US:-PROBA COMPRESIUNIIPROBA COMPRESIUNII ESTE NEGATIVA IN ESTE NEGATIVA IN NODULUL MALIGN:la apasare cu traductorul nodulul nu NODULUL MALIGN:la apasare cu traductorul nodulul nu se aplatizeaza(un chist sau adenom se aplatizeaza)se aplatizeaza(un chist sau adenom se aplatizeaza)(cancer (cancer ductal T 2)ductal T 2)
compresiune
Infiltratie pectoral
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US:US:Carcinom mamar:microcalcificariCarcinom mamar:microcalcificari
HISTOGRAMA
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US::Carcinom invaziv T-2Carcinom invaziv T-2
-nodul hipoecogen cu contur neregulat, structura neomogena, microcalcificari,ax mare vertical, cu discret con de umbra posterior.
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US mod B:microcalcificari abundente abundente
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US:CANCER MAMAR cu NECROZA CENTRALA
-macronodul reflectogen cu contur neregulat, dintat,cu zona centrala anfractuoasa hipoecogena/ partial chiar transsonica
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ULTRASONOGRAFIE: ULTRASONOGRAFIE: CANCER VOLUMINOS T-3-4CANCER VOLUMINOS T-3-4ULTRASONOGRAFIE: ULTRASONOGRAFIE: CANCER VOLUMINOS T-3-4CANCER VOLUMINOS T-3-4
Ce mai e de facut ..?! (doctor suparat)
DIAGNOSTIC SIMPLU CLINIC SI USTRATAMENT PALIATIV:FAZA CURABILA DEPASITA
Rad/Imag.Iasi-2002Rad/Imag.Iasi-2002
Evitarea acestei situatii=
SCREENING MAMOGRAFIC !!
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CARCINOM DUCTAL in situ
CanalCanal dilatat dilatat
Canal dilatat -nodul reflectogen in lumenul unui canal galactofor dilatat(transsonic); -nodulul nu are delimitare neta parietala,are baza sesila si peretele ductal este ingrosat.
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SEMIOLOGIE DOPPLER
STUDIUL DOPPLER CFI SI ANGIO POWER:
•TIPURI DE VASCULARIZATIE TUMORALA:
-vase de neoformatie vizibile intratumoral-central ;
-vase de neoformatie vizibie-periferic (halou);
-hipovascularitate (1-2 vase discrete);
-avascularitate-nu se evidentiaza vase de neoformatie
SEMNALUL DOPPLER CRESTE INTENS DUPA SUBSTANTA DE CONTRAST ULTRASONIC I.V.
STUDIUL DOPPLER CFI SI ANGIO POWER:
•TIPURI DE VASCULARIZATIE TUMORALA:
-vase de neoformatie vizibile intratumoral-central ;
-vase de neoformatie vizibie-periferic (halou);
-hipovascularitate (1-2 vase discrete);
-avascularitate-nu se evidentiaza vase de neoformatie
SEMNALUL DOPPLER CRESTE INTENS DUPA SUBSTANTA DE CONTRAST ULTRASONIC I.V.
Rad/Imag.Iasi-2002Rad/Imag.Iasi-2002
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US Doppler Angio PowerUS Doppler Angio Power
Halou periferic
Vase centrale
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CANCER MAMAR:aspect hipovascular (Doppler CFI)CANCER MAMAR:aspect hipovascular (Doppler CFI)
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20”
30” 60”
1 2
3 4CANCER MAMAR:DOPPLER & Levovist ®
Vase neoformate cu semnal Doppler intensDupa LEVOVIST
FARA CONTRAST i.v.
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Cancer mamar T-4 c:adenopatia axilaraCancer mamar T-4 c:adenopatia axilara
-ganglion marit , globulos cu zone hipoecogene in strucura,cu vase neoformate la examinare Doppler
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TERMOGRAFIATERMOGRAFIA
METODA DE VIZUALIZARE IN COD DE CULORIMETODA DE VIZUALIZARE IN COD DE CULORI
A TEMPERATURILOR CUTANATE:A TEMPERATURILOR CUTANATE:RECE=RECE=ROSU;ROSU;
CALD=CALD=ALBASTRU;FOLOSESTE: ALBASTRU;FOLOSESTE: RADIATIA RADIATIA INFRAROSIE(teletermografieINFRAROSIE(teletermografie),),CONTACTCONTACT(folie cu (folie cu cristale de colesterolcristale de colesterol) sau ) sau MICROUNDELE.MICROUNDELE.
In voga mare in anii ‘75-80,areIn voga mare in anii ‘75-80,are o acuratete indoielnicao acuratete indoielnica si o si o specificitate redusa deoarece nu pune in evidenta direct specificitate redusa deoarece nu pune in evidenta direct tumora si nu o poate masura;confuzia cu infectii si stari de tumora si nu o poate masura;confuzia cu infectii si stari de hiperactivitate hormonala mamara este frecventa si de hiperactivitate hormonala mamara este frecventa si de aceea aceea METODA este in curs de a fi ABANDONATA IN METODA este in curs de a fi ABANDONATA IN MAJORITATEA CENTRELOR MARI DE ONCOLOGIEMAJORITATEA CENTRELOR MARI DE ONCOLOGIE
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TERMOGRAFIE:TERMOGRAFIE:CANCER DUCTAL=>STINGACANCER DUCTAL=>STINGA
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TERMOGRAFIE:TERMOGRAFIE:CANCER MAMAR=> DREAPTACANCER MAMAR=> DREAPTA
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Imagistica cu Rezonanta Imagistica cu Rezonanta Magnetica Magnetica
METODA RECENT INTRATA IN ARSENALUL IMAGISTICII
Foloseste Foloseste anteneantene de radiofrecventa speciale,”phased array”, de radiofrecventa speciale,”phased array”,
dedicatededicate explorarii mamare. explorarii mamare.
Rezolutia detaliilor structurale este mare,imaginile se obtinRezolutia detaliilor structurale este mare,imaginile se obtin
atit pentru mase nodulare cit si pentru studiul vaselor deatit pentru mase nodulare cit si pentru studiul vaselor de
neoformatie.Semeiologia IRM a patologiei mamare este neoformatie.Semeiologia IRM a patologiei mamare este inca in inca in curs de studiere.curs de studiere.
Metoda este insa prohibitiva ca pret si nu este folsita ca metoda
rutiniera sau de screening in patologia mamara,ci numai in dg. diferential al unor noduli incerti ,in aprecierea extenziei cancerului mamar si vizualizarea cancerelor multiple in acelasi sin.
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IRM STIR/SAG:SIN CU STRUCTURA NORMALA
© Rad/Imag.Iasi-2002
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SEMIOLOGIE IRM SEMIOLOGIE IRM
• BENIGN:-lobular=40%;-rotund=32%;-contur net,regulat,neted=78%-contrastare:lenta,tardiva,persistenta,central-centrifugala;• MALIGN:-rotund/neregulat-85%;-contur anfractuos,sters,difuz,spicular-80%;-contrastare;precoce,rapida,intensa,periferi-
ca-cecentripeta;+-fugace
• BENIGN:-lobular=40%;-rotund=32%;-contur net,regulat,neted=78%-contrastare:lenta,tardiva,persistenta,central-centrifugala;• MALIGN:-rotund/neregulat-85%;-contur anfractuos,sters,difuz,spicular-80%;-contrastare;precoce,rapida,intensa,periferi-
ca-cecentripeta;+-fugace
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IRM T2/SAG.:MASTOZA FIBROCHISTICA
PLACARD
cy
cy
© Rad/Imag.Iasi-2002
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MFK:CHISTURI NUMEROASE,FIBROZA
-imagini numeroase rotunde ,net conturate,cu intens hipersemnal T2-(lichid)
© Rad/Imag.Iasi-2002
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IRM STIR SAG.:FIBROADENOM
-macronodul cu contur net,capsular,cu septuri fine si regulate intern, cu hipersemnal T2 mediu
© Rad/Imag.Iasi-2002
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SEMIOLOGIE IRM :
Chist cu sediment
versus
Carcinom ductalCarcinom ductal
CRITERII dg.dif.:
-forma-contur
-structura-tesutul perilezional
subtractie
Diag.diferential
T
-neregulat;neomogen;cu prelungiri;invaziv
-regulat,omogen;cu contur net;neinvaziv
cy
© Rad/Imag.Iasi-2002
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Carcinom ductal invaziv:
Studiu post-contrast(MAGNEVIST,Schering AG)
Carcinom ductal invaziv:
Studiu post-contrast(MAGNEVIST,Schering AG)
Gado-90”
Gado-360”
-captare rapida,intensa,dela periferie spre centrul nodulului
© Rad/Imag.Iasi-2002
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T1-post-Gado +subtractie:
Carcinom ductal invaziv bipolar
limfangita
© Rad/Imag.Iasi-2002
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Carcinom ductal T3 ,limfangita si adenopatia axilara (N1)
limfangita
© Rad/Imag.Iasi-2002
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ANGIO-RM:ANGIO-RM:
Cancer ductal Cancer ductal invaziv –T-3: invaziv –T-3: vase de neoformatie
-dupa contrast paramagnetic i.v. se vizualizeaza vase intratumorale dispuse anarhic central si circular-in halou la periferie
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PUNCTIA & REPERAJUL PUNCTIA & REPERAJUL PREOPERATORPREOPERATOR
GHIDATE IMAGISTICGHIDATE IMAGISTIC
1)GHIDARE MAMOGRAFICA STEREOTACTICA1)GHIDARE MAMOGRAFICA STEREOTACTICA
2)GHIDARE GALACTOGRAFICA2)GHIDARE GALACTOGRAFICA
2)GHIDARE ULTRASONOGRAFICA2)GHIDARE ULTRASONOGRAFICA
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TEHNICA PUNCTIEI GHIDATE US US
30˚30˚
ac
Acul se introduce sub unghi de 30°fata de fasciculul US,pentru a fi vizualizat in timp real
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acac
PUNCTIE-BIOPSIEPUNCTIE-BIOPSIE
AC FIN INAC FIN IN
CANCER MAMARCANCER MAMAR
Rad/imag.IasiRad/imag.Iasi
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PUNCTIE-CITOLOGIE ECO-GHIDATAPUNCTIE-CITOLOGIE ECO-GHIDATA : : A)A)nodul mic,ac reflectogen ,vizibil in centrul nodulului; nodul mic,ac reflectogen ,vizibil in centrul nodulului;
B)frotiul obtinut:celule maligne (carcinom ductal T-1) B)frotiul obtinut:celule maligne (carcinom ductal T-1)
acac
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CANCER DUCTAL MIC: CANCER DUCTAL MIC: A) US; B)reperaj mamografic cu fir-cu cirlig(“hook wire”) A) US; B)reperaj mamografic cu fir-cu cirlig(“hook wire”)
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IMAGISTICA OBSTETRICALA
IMAGISTICA OBSTETRICALA
I)SARCINA NORMALA: -DG.PRECOCE (2 SAPT); -VIABILITATE;MASURATORI;
-VIRSTA SARCINII;
- monitorizare:DBP,LF,CA etc
-sex fetal probabil;
-data probabila a nasterii:
II)SARCINA PATOLOGICA: -avort iminent/in evolutie; -sarcina extrauterina;
-malformatii embrio-fetale; -anomalii fetale (6-9 luni)
RAD.INTERVENTIONALA:-transfuzie in utero-incompati-bilitate de Rh,ghidata US;-manipulare ecoghidata intrauterishunt pt.hidrocefalie,drenaj urinar pt megaureter etc.
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RX abdominale:sarcina la termen GEMELARA
Metoda…istorica..
Craniu 1
Craniu 2
Col vert.
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EMBRION
PLACENTA
US:SARCINA NORMALA ENDOUTERINA=>5 SAPTAMINI
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US 3D: SARCINA 11 SAPTAMINI;embrion,lichid amniotic
Reconstructie de suprafata
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US : SARCINA 12 SAPTAMINI; procesare tridimensionala
prin reconstructie de suprafata.
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US:SARCINA GEMELARA(2 SACI OVULARI)-4 SAPT.
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US 3D:SARCINA GEMELARA BIAMNIOTICA,BICORIONICA
Reconstructie de suprafata
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US 3D:SARCINA GEMELARA MONOCORIONICA
Reconstructie de suprafata
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Diametrul bi-parietalDiametrul bi-parietal
US 3DUS 3D:FACIES SI MINA FETALA IN RECONSTRUCTIE :FACIES SI MINA FETALA IN RECONSTRUCTIE DE SUPRAFATADE SUPRAFATA
Mina fetala
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US:CRANIU FETAL LA 32 SAPTAMINI DE GESTATIE
DIAMETRUL
BI-PARIETAL
(DBP)
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US DOPPLER COLOR:CORDON OMBILICAL
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US 3D:COL.VERTEBRALA FETALA SCOLIOTICA
RECONSTRUCTIE DE SUPRAFATA
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US 3D,reconstructie de suprafata:m.inferioare fetale si sex.
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MÎNA FETALA-24 SAPT
US 3D
Reconstructie de suprafata
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US 3D:SEX FETAL…FEMININ
Reconstructie de suprafata
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SEX FETAL….MASCULINSEX FETAL….MASCULIN
Reconstructie de suprafata
US 3D
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…SEX…IN UTERO…….
SCROT
PENIS
Mîna
US 3D
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US 3D:FACIES FETAL LA 30 SAPTAMINI
Reconstructie de suprafata
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US mod B & Doppler:PROFIL FETAL: SEMNUL “SUPTULUI”(DOPPLER)
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US 3D:FAT SUGINDU-SI POLICELE
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US 3D:FETUS 24 SAPT
“BOXERUL…..”
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US- 3D:FACIES SI MEMBRE
..”GÎNDITORUL..”
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“FLAUTISTUL…”
US 3D:fat 12 saptamini:facies si m.superioare
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…….”VAI DE CAPUL MEU….”
US 3D:FETUS 11 SAPT.
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US 3D:PROFILURI FACIALE FETALE NORMALE
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US 3D:BUZA DESPICATA(“DE IEPURE”)
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US 3D:PROFIL de FACIES FETAL;MALFORMATII
DOWN MICROGNATIE SD.APERT
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US 3D:US 3D:PROFIL FETAL:ACHONDROPLAZIE
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US: AVORT IN EVOLUTIE
-sac ovular cu decolare,halou transsonic in jur
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US: SARCINA INTRAUTERINA & FIBROM
Sac ovular
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US: SARCINA EXTRAUTERINA-ANEXA DR.
Sac ovular
Lichid inDouglas
uter
vezica
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US:SARCINA EXTRAUTERINA
-formatiune lichidiana in anexa stanga
vezica
uter
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PROFIL FETAL 3D-spin
FAT 32 SAPTAMINI
CLICK-pe imagine
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